Provider Demographics
NPI:1083695142
Name:BOWERS, KELLI (LCSW)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:BOWERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 N ELDORADO AVE
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-6418
Mailing Address - Country:US
Mailing Address - Phone:541-883-1030
Mailing Address - Fax:
Practice Address - Street 1:2210 N ELDORADO AVE
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-6418
Practice Address - Country:US
Practice Address - Phone:541-883-1030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT121040-35011041C0700X
ORL13415101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT682028OtherDMBA
UT1041C0700XOtherTAXONOMY
UT261QR0405XOtherSUBSTANCE ABUSE
UT01210403501001OtherBLUE CROSS
UTP00117833OtherRAILROAD MEDICARE
UT942938348014Medicaid
UT107032367010OtherIHC
UT942938348OLSOtherEDUCATOR'S MUTUAL
UT682028OtherDMBA
UT942938348OLSOtherEDUCATOR'S MUTUAL
UT261QR0405XOtherSUBSTANCE ABUSE
UT01210403501001OtherBLUE CROSS
UT942938348014Medicaid